The United States Food and Drug Administration (FDA) has evaluated the risk of suicide associated with antiepileptic drugs. The FDA examined 11 antiepileptic drugs, among nearly 28,000 patients, and found that patients taking an antiepileptic drug have an increased risk for suicidal behavior or ideation, compared to 16,000 patients receiving a placebo.

The FDA’s assessment consisted of reviewing 199 placebo-controlled trials evaluating the safety and efficacy of various antiepileptic drugs (also known as anticonvulsants). The following drugs were included in the review: carbamazepine (Carbatrol, Tegretol), felbamate (Felbatol), gabapentin (Neurontin), lamotrigine (Lamictal), levetiracetam (Keppra), oxcarbazepine (Trileptal), pregabalin (Lyrica), tiagabine (Gabitril), topiramate (Topamax), valproate (Depakote, Depakene, Depacon), and zonisamide (Zonegran). Although only these drugs were included in the review, experts suggest that all anticonvulsant drugs carry the same risk. Antiepileptic drugs are not just used to treat epilepsy. They can be used to treat psychiatric disorders, including bipolar disorder, depression, and anxiety, as well as migraines and neuropathic pain.

Overall, the risk of suicide is double for patients receiving an antiepileptic drug, compared to patients receiving a placebo. Approximately 2 patients per 1000 exhibited suicidal thoughts or behaviors when treated with an antiepileptic drug. A total of 4 patients completed suicide among the treatment groups, while no suicides occurred in the placebo groups. The risk for suicidal thoughts and behaviors was higher in patients with epilepsy, versus psychiatric or other conditions, in the FDA’s evaluation.

All of the drugs evaluated in the study appear to have a similar risk of suicidal thoughts and behaviors. The risk was also consistent across all major demographic groups studied. Only patients aged 5 years or older were included in this analysis, with an average age of 42 years. Slightly more than half of the patients were female and more than three-quarters were white. The only subgroup of patients that showed a slightly higher risk of suicidal behavior was non-North American patients, versus patients who resided in North America. 61% of patients evaluated were from North American locations.

The increased risk of suicide was seen as early as one week after starting treatment with an antiepileptic drug, and continued for at least 24 weeks. (Most of the trials included in the review did not extend past 24 weeks, so suicidal thoughts and behaviors after this time cannot be accurately assessed.)

Healthcare professionals are advised to use this information when prescribing antiepileptic drugs for any patients. The risks associated with the drugs should be balanced with the benefit obtained from the treatment.

Patients and families must also be aware of the risks associated with antiepileptic drugs and monitor patients for emerging or worsening depression, anxiety, hostility, or mania. Patients should not stop taking an antiepileptic drug without first discussing it with their healthcare providers.

The FDA is currently working with manufacturers of antiepileptic drugs to require additional safety information and warnings in the each of the drug’s labeling.

Your readers should be aware of a new FDA approved treatment for patients that do not have an adequate response to traditional antiepileptic drugs. It is called vagus nerve stimulation (VNS) therapy, a 90-minute out-patient surgical procedure. It is considered a low risk operation by neurosurgeons and neurologists.

Epilepsy patients often suffer from depression. Epilepsy can affect those key areas of the brain responsible for mood and depression. The identical procedure (VNS) is also FDA approved to treat major depressive disorder. Vagus nerve stimulation can help alleviate both diseases.

I would visit VagusNerveStimulation.com to learn more information about this treatment that can potentially improve the quality of life for epilepsy patients.

I find this article very interesting – I wasn’t aware of the study but can certainly attest to the side-effects of antiepileptic drugs. Our son was diagnosed with epilepsy when he was 9 years old and immediately went on drugs. His personality changed – depression and aggression set in. We attributed this to his age and finding his identity as a teen. Fortunately after he entered his late twenties he was able to go off medication and control any possible seizures through meditation and diet. However, not all cases are the same and I certainly don’t suggest anyone try to go off meds without the assistance of a medical practitioner.

I would be curious to read a study about the correlation between epileptics who are not on drugs and their risk of suicide. I think most epileptics, drugs or not, already have a high rate of suicide simply based the nature of their condition.

Jennifer Gibson, PharmD, is a practicing clinical pharmacist and medical writer/editor with experience in researching and preparing scientific publications, developing public relations materials, creating educational resources and presentations, and editing technical manuscripts. She is the owner of Excalibur Scientific, LLC.

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